IDAS Request Form · REC15/0011

Department of Infrastructure, Local Government and Planning

 

Table C—premises coordinates (appropriate for development in remote areas, over part of a lot or in water e.g.
channel dredging in Moreton Bay)

 

 

 

Coordinates Zone Datum Local government
(note: place each set of coordinates in a separate row) reference area (if applicable)
Easting Northing Latitude Longitude

[| Gpao4

[_]wess4

Cl Other

 

 

 

 

 

 

 

 

5. Details of the proposed change

 

 

 

henenintakte Covdihoa Bo allow Re extatns Awelias On Ue atte.
te Nemann regi Ae. cormpltance 22SE5 NO OESEES br
(2. Oc hed Aime tee. .

 

 

 

6. Is owner’s consent required for this request? (refer to notes at the end of this form for more information)

 

fk] No

CO Yes—complete either table D or table E as applicable

 

Table D

 

Name of owner of the land

 

 

|, the above-mentioned owner of the land, consent to the making of this request.

 

Signature of owner of the land

 

Date

 

 

 

 

Table E

 

Name of owner of the land

 

 

C] The owner's written consent is attached

 

 

Request to change existing approval template -3-